The use of cartilage as a grafting material has been advocated in cases at high risk for failure, such as subtotal perforations, adhesive processes, tympanosclerosis and residual defects after primary tympanoplasties. The cartilage palisade technique, in which the TM is fully reconstructed with palisade-shaped cartilage pieces, was first described by Heermann. Cartilage material has been critized because of concerns regarding hearing results, however, large cartilage plates with thicknesses <= 0.5 mm have been suggested as an acceptable comprise and the graft take of this technique has been reported to be excellent. The purpose of this study was to compare the graft take rates and hearing results of primary type I cartilage tympanoplasty operations with palisade technique with those of primary tympanoplasty using temporalis fascia in a homogenous group of patients. Study design: retrospective chart review. Setting: tertiary medical center. The study population included 51 patients who were operated between January 2000 and 2006 at the Department of Otorhinolaryngology of Ataturk Training and Research Hospital, Izmir, Turkey. Primary tympanoplasty cases with pure subtotal perforations (perforation > 50% of the whole TM area), intact ossicular chain, at least more than 1 month dry period and normal middle ear mucosa were included in the study. Palisade cartilage tympanoplasty group included 23 cases, whereas 28 patients were were in the fascia group. Intervention: therapeutic. Graft take rates were noted in 51 patients and pre- and post operative audiograms were compared using the chi-square test with Yates' continuity correction, Fisher's exact test, t test and repeated measures ANOVA. Graft take was achieved in 22 patients (95.7%) in palisade cartilage group and in 21 patients (75%) in temporalis fascia group (P = 0.059). Mean speech reception treshold, air-bone gap and pure-tone average scores comparing the gain between both techniques showed no significant changes in the threshold (P > 0.05). However the functional success was achieved with the palisade cartilage technique postoperatively, regarding to mean air-bone gap and speech reception threshold changes. Our experience with palisade cartilage technique demonstrates that subtotal or total perforations at high risk for graft failure, can be treated efficiently and a durable and resistant reconstruction of the TM with reasonable hearing can be achieved.